| NPI | 1952466344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: CA PSY18093) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY18093) |
| 103T00000X Psychologist (Licence: CA PSY18093) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY18093) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2010-10-18 |